Provider Demographics
NPI:1447330287
Name:FERGUSON, JANE S (APRN/PC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:S
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:APRN/PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2924
Mailing Address - Country:US
Mailing Address - Phone:508-860-1215
Mailing Address - Fax:508-860-1236
Practice Address - Street 1:162 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2924
Practice Address - Country:US
Practice Address - Phone:508-860-1215
Practice Address - Fax:508-860-1236
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult